Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Abstract

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction.

Sedation for Colonoscopy: Comparison of Remifentanil and Alfentanil Combined with Propofol/Midazolam

“…In a study with incremental propofol administration in the midazolam/fentanyl and midazolam/ fentanyl/ketamine groups, propofol dose was found to be significantly lower in the second group (11). In the pre-anesthetic administration of fentanyl and propofol with and without midazolam, propofol consumption is lower in the midazolam (0.05 mg kg -1 ) group (17).…”

Doxapram alleviates low SpO2 induced by the combination of propofol and fentanyl during painless gastrointestinal endoscopy

“…Gastrointestinal endoscopy is a common procedure for prevention, diagnosis, and treatment of a variety of symptoms and diseases of the stomach and lower digestive tract. Sedation or anesthesia is an important means to increase comfort and decrease anxiety, discomfort and pain during the endoscopic maneuver [9]. Propofol is a satisfactory intravenous anesthetic due to its short half-life, fast emergence from anesthesia, and low incidence of nausea and vomiting.…”

Analgesic, anti-inflammatory and immuno-modulatory effects of dezocine-propofol anesthesia combination following colonoscopy

“…Propofol has a sedative effect, while both dezocine and fentanyl exert analgesic effects. Dezocine activates κ receptor in cerebral cortex, leading to slow onset and long duration of analgesia [3,7,8], Table 3: Serum levels of inflammation-related endocrine hormones before and after colonoscopy examination (mean ± SD) while fentanyl brings about fast onset but shortlived analgesia through activation of the μ and δ receptors in the central nervous system (CNS). Thus the use of fentanyl after colonoscopy examination is not ideal.…”

“…Dezocinepropofol and fentanyl-propofol are two kinds of frequently used anesthetic combinations for achieving painless colonoscopy. Dezocine and fentanyl exert analgesic effects, the former through activation of κ receptor in the cerebral cortex, and the latter through excitation of μ and δ receptors in the central nervous system (CNS) [3][4][5]. The present study was carried out to compare the anti-inflammatory and immunomodulatory effects of these two types of unaesthetic combination at various stages of colonoscopy.…”